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Scott Atlas Education. (2013) BookTV at the Hoover Institution Scott Atlas, 'In Excellent Health Setting the Record Straight on America's Health Care.' New.

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  CSPAN    Book TV    Scott Atlas  Education.  (2013) BookTV at the Hoover  
   Institution Scott Atlas, 'In Excellent Health Setting the Record...  

    May 12, 2013
    1:25 - 2:00pm EDT  

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would have you believe. he also takes a critical look at the patient protection and affordable care act, commonly known as obamacare and another alternative like the single-payer system. this is about half an hour. >> setting the record straight on america's health care. that is the name of the book. the author is doctor scott doubtless, m.d. he is a senior fellow here at the hoover institution on the campus of stanford. doctor, what works about the american health care system when you look at it in the larger sense? >> what really works is what the book is about. and that is the actual medical care, availability and access as well as implementation or introduction of diagnostics and
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a lot of these writing of the book was to clarify the background information that people don't really have. despite what has been said about the u.s. health care system. the bottom line it is superb and both access to quality of care. >> what about cost? >> cost is an issue, it is well documented. i concur with the documentation that the u.s. is the most expensive system for health care in the world, whether that is per capita or any other metric. this is really the major problem that should be where the reforms are directed. to bring down costs. >> some of the reforms have been directed towards bringing down costs. having not worked always? >> well, if you're talking about the basic affordability care act
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now called obamacare, actually, when you look at the numbers, the projections are actually not that the cost will come down. it was put forth as one of the reasons why reform is so essential. when you look at the government's own estimates for the centers for medicare services on all of the other agencies, none of them really project a decrease in health care expenditure compared to pre-obamacare. so this is really one of the ironies of this whole discussion about it. >> the health care costs have never gone down, have a? >> you make a very good point. they don't generally go down historically. because it's not necessarily desirable to make them go down. so for a variety of reasons, the most important it is technology and medical care that has
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advanced over the past 15 to 100 years. but we wouldn't want to dial back the clock to let say when i was born in the 1980s when the bedside diagnosis was the essence of this diagnosis. the technology, whether it is diagnostic or minimally in basement, it has actually been eight room for quality of medical care. so there is a driver that you really don't want to scale back on. that things cost money. however, there are ways to increase this. i use the word control. as a believer in free market control, let people decide what value the medical care has for them, unleash competitions and the barriers for competitions,
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use the information and by virtue of those kinds of things, as of every other service in the united states, the price does come down. i get asked this by my own children. if your price is the price the people are willing to pay at a fair price. not an arbitrary price by some central authority. >> are you a practicing doctor right now? >> i have been up until one year ago when i moved from being the head of neuroradiology where i was for about urging of 14 years at stanford and before that, practicing clinical medicine and doing research and teaching. one year ago i moved full-time to hoover to work on health care policy. >> when you were a practicing physician, did you accept medicare payments and patients?
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>> yes, i will give you my own information and background. yes, we did. >> to the government reimbursed at a fair rate? >> well, that's a difficult question to answer. because it implies a subjective term banner. did they reimbursed? yes. the rate was arbitrarily determined. it was significantly less always than private insurance. one way to assess it would be to judge how doctors in general, how they react to the reimbursement rate. when you look at how they react to the reimbursement rate, the reaction is that there is a decrease in the number of doctors that are accepting medicare and medicaid patients
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because of the low reimbursement rates. therefore they lose money. as we know, he can't make up for losing money per patient. >> doctor, you speak about some of the barriers to what you call health care and the fair market. what are the barriers to you like to see? >> well, one of the biggest barriers is really the third-party payer system in general. and that is the lack of information. people use this service and medical care. it's the only one like this without knowing what cosper and we don't know what it cost until after you have already viewed the facts. so obviously, there is no possibility of making a value-based decision. secondly, essentially, all of medical care, and this is a little bit of an oversight, it
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is covered by insurance itself very what i mean is the way health insurance has evolved, it has changed the way insurance intended, which is a way to reduce risk exposure to large expenses. now health insurance aside from a small copayment for a relatively small deductible for most people, it is paid by the insurer. so you don't really care what it cost. because someone else is paying. of course, you are paying in the end, but it's a very complicated process. so the biggest barrier is that there is no incentive to even look at the cost. when something is free, with we think that we should consume as much of it as we want because i'm not paying work. so that is the number one very and barrier. the second is the government
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created health insurance coverages themselves. as we know, the united states controls health insurance. so it's kind of two segments to that. the first is that you are not allowed to buy insurance outside of the state in which you live. this is, of course, nonsensical and doesn't really exist with other goods and services. and then it is a paternalistic way to view things when you are afraid that you won't know what you're doing when you go, if you live in new jersey i don't know why those people couldn't shop in pennsylvania or vice versa. that is one problem. it's kind of like monopoly and a barrier of competition. the second issue with the state is that there are well over 2000 mandates that are requirements for all health insurance policies to cover things that
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many people, i think, rather obviously, would never want to pay for. massage therapy, acupuncture, chiropractors, in vitro. when i give people a lecture, most of the people here are not going to use in vitro fertilization. in insurance is required this would be cheaper. they can always buy what they want. there are a whole host of things that i think government had an opportunity for us, a big one that i failed to mention. the lack of information. it's not just about price. it is about polity. there is no transparent we end
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up they actually do a lot of procedures, the question then comes on value-based decisions and are they able to make these decisions, medicare is so complicated, how can you make a decision like that. my answer is that we can make decisions like patients. because we do this all the time because we don't understand. i'm not sure many people can explain how a computer really works in very great detail.
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i think in concert with doctors and in the age of installation and the internet and et cetera, people are actually very good at talking from the patient's side about what the medical care entails, given the opportunity and the incentive. there are a variety of ways to do that. the so-called marketplace has been created where people can shop for insurance and perhaps get competition. is that a step in the right direction? >> okay, you are talking about health insurance exchanges which have turned the marketplace. in general, the concept is very
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good. the first problem is that there is the so-called minimum essential benefits coverage. and this is like minimal essential benefits. the problem is when you look at those, such enormous comprehensive list of medical benefits that the price of the policy to cover all those things is high and eliminates the possibility for people to buy insurance policies and pay for them to be exactly what they want.
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the prices are jacked up because this coverage is required of the policies that are eligible to be sold in health insurance exchange-rate secondly, we have a minimum loss ratio. we look at a minimum loss ratio, you have limited cheaper coverage under high deductible health care plans. they are not only cheaper, but they are actually more desired, they are the most popular choice over the past five years. and the increase in that choice has been employer to sponsors health insurance by employees because they are the high deductible.
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one of the most important things is the idea that health insurers, no matter what mission you have, you must be able to get the insurance and eliminates the waiting. so you would be able to buy insurance if you just waited for these days with no problem. so makes people think, okay, why would i bother to have insurance if i got sick. and that would be the rational way to dig through this. and then the thirdo real differn
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the premiums for the risk factors, except for cigarette smoking. so you are not allowed to change the prices on the basis of much of anything. everyone had the same prices, guaranteed issues, no matter what risk you are behaving in for behavior. and there are no real delays in buying insurance. again, these things are going to make insurance companies kind of a no-win situation. it's not really possible to exist under that kind of scenario. >> the arguments that you said about excellent health -- is it too late to implement them since we are already on the road to this? >> this is something that is a very good question. i don't know that i have a real answer to that. although we can say that i think it is clear that unless
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something dramatic happens in the election, obamacare is really a law. i think that realistically it is completely abolished. maybe other people disagree with me. i'm sure that there are some. but given that scenario, there are names that can be modified. for instance, there are bills passed all the time, although they are not really being implemented yet. i'm not sure that they will be. to get rid of some of the edict of medical device companies that will necessarily cause job loss, but also have technology is there in place for patients. a lot of the senate members can agree on is because of tax their own constituency.
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then we can go through the ideas about how to change these requirements with the exchanges that i have mentioned. i don't think it's too late to modify and even dramatically change hearts of the aca. i have a feeling that it is unrealistic to say that the entire law will be repealed. >> you have talked about americans having good access to health care. if some of that access to emergency rooms? >> well, if you look at the data, i think that the answer is probably no to that. there are two parts of this. the one part is to clarify that there is a huge difference in access to health care. no matter how you define it, whether it is access to specialists, access to general
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care, access to procedures. for americans, far better than any of the other countries. >> they make sure that people don't get access to care. there are people they get access to care that really don't need emergency rooms.
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this is remarkably distorted. >> to the embarrassment of the government to centralize health care, government officials circumvent restrictions when their own personal care is at stake. the national health service in great britain spent more than 1.5 million pounds to have staff members leapfrog through the waiting list. one individual chose to have his pacemaker surgery at the renowned cleveland clinic in 2006. and when president obama was part of the single-payer systems and was asked pointedly to promise that he would not seek care for his wife or daughters come in the president refused, saying it's my family member or wife, if it's my children, it was my grandmother, i always want them to get the very best of care. >> that is exactly right.
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i think that people ought to know that even the most vocal proponent in the united states, single-payer health care, when they are faced with health care, they do everything they can to manipulate the system and access their own right, which is choice. they want choice to pursue health care options for themselves. i know this because i have been one of the doctors sought out frequently by several people, including some who are not on the record. this includes senator ted kennedy. it was in the public record. i read the mri scan when he had his brain tumor. it is not that he was my patient. he sought out the best doctors in the country to help him. in the political world he was
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pushing single-payer health care for the rest of us. i think you make a broader point. we seek a way these barriers. but we even have put into law how we will pay for medical care either in project care centers or outside of their own countries. because they cannot handle the access problem in their own country. so i'll be in the u.s., while we somehow have been moving toward a more naturalized system, the countries that have the experience -- they have made significant movement towards privatization.
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>> there are people watching this interview and they will be saying to themselves, well, he is a doctor. he makes xml and of dollars. he needs to make less dollars, he is making too much. >> well, you know, i think it's been said many times, but it's not a surprise. unfortunately, i don't make that much money. but that is aside the point. i think that we have to look at that this is a tricky part of health care. this is the kind of ethical and moral dilemma that takes place in the discussion, which is health care is different from everything else. health care is a right. in the ideal world, everybody would have everything for free
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everyone should have food, it doesn't work that way. the reality of life is things cost money. nobody guarantees equal opportunities. when you apply that to doctors, you know, you definitely pay for things in some sense. if you want to have a medical system where everyone is working
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in the private sector and public sector jobs with limits on what they earn and aided by government, you better be prepared to have medical care function and there is a reason why doctors flock from all over the world to be with the daughters of the united states. i have been engaged for many years in continuing medical education courses both here and abroad. by far, the leaders in innovation, but if you want to make doctors into this area of public employees, we have already seen a little bit of
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this. when we look at the surveys of doctors and their future plans and many doctors are getting out of the field. you will see the best and brightest. which i'm not arrogant enough to say that the best and brightest are like this. this includes the medical field of the united states. if you want to clamp down on things and start telling them what they're going to earn an avid cost and all these other things of delayed return on investment if you will because you don't start making money until you're in your mid-dirties, that is how they are making extra money and everyone has to pay for that
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people think that oh, these radiologists releasing people order mris and ct scans may make money from it. no, that is legal illegal in the united states. it is not true. nobody can order a diagnostic test. it is true that there is redundancy in the u.s. and certainly attempts going on with those who streamline the system, getting rid of waste and redundancy. but i would say that's not the biggest problem at all.
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>> so as the health care slower than what you are saying to a nazi you have to look at the actual duddy themselves, which i have done in this book, rather than just look at the bottom line. i wrote this after dinner party discussing a michael moore movie. the u.s. health care system, for instance, the world health organization has ranked 37th in the world. and this includes places that don't render common sense assessment tests i or so i thought, okay, let me look at these studies in specific detail. this has been done now in the academic literature of public
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health. we know that the studies were seriously flawed. almost two thirds were comprised of scores based upon the equality. in essence, that was medical care where everyone was able to be deemed better and there are many other things that are set up in the year 2000, such as when there was no data available. >> they literally fill them in. ahead of health care is actually
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defined in ways the way u.s. had a bad ranking. >> would he think of the male model? >> that is that they have a referral center.
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they do things their own way they have all kinds of things going on right now to make it more attractive. we are talking with dr. scott atlas and the name of the book is "in excellent health: setting the record straight on america's health care." we thank you for being here.
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>> tweet us at booktv.com. >> the situation in afghanistan was just we talked about those parties today. the president, from much of the 1970s was a vacuous modernizer. and he was very quickly running the ground aground and the whole country rose up against him.
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it has completely wiped out the old afghanistan that was on the 60s and 70s. >> revolutionary islam. christian carillon 1979. >> we argue that our economy needs to be more responsive to the system. >> this is about an hour. up with.
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>> hello, my name is gar alperovitz. i'm professor at the university of maryland. we are much more interested in doing activist work in washington. bob was a very liberal congressman. so i have a checkered career. i came out of politics and history and economics and i have written this book. i should say that i'm really pleased to be here.
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it's a small bookstore that has a backbone in america. >> this book is part of the title. the question is what is facing the country in what must we do. that is a question that a lot of people are being asked for themselves around the country. i wrote this book in a strange way. and some of you know, i wrote a very long book about the.
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my wife teases me. five years, 10 years, that kind of thing. in what became the basis of this book for a long time. ..